Provider Demographics
NPI:1346471570
Name:BURNES WEST HOME
Entity Type:Organization
Organization Name:BURNES WEST HOME
Other - Org Name:BURNES WEST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPONSOR
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-857-0047
Mailing Address - Street 1:15266 N 145TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8519
Mailing Address - Country:US
Mailing Address - Phone:480-857-0047
Mailing Address - Fax:
Practice Address - Street 1:15266 N 145TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8519
Practice Address - Country:US
Practice Address - Phone:480-857-0047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3369320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities